http://www.medscape.com/viewarticle/443831_7

November 2002
Highlights From the 127th Annual ANA Meeting
Medscape Neurology & Neurosurgery 4(2), 2002

The US Food and Drug Administration has approved 5 injectable immunomodulatory treatments for multiple sclerosis (MS), including weekly intramuscular interferon beta-1a (Avonex; Biogen, Inc; Cambridge, Massachusetts), thrice-weekly subcutaneous interferon beta-1a (Rebif; Serono; Rockland, Massachusetts), every-other-day subcutaneous interferon beta-1b (Betaseron; Berlex; Montville, New Jersey), daily subcutaneous glatiramer acetate (Copaxone; Teva Pharmaceutical Industries Ltd; Petach Tikva, Israel), and intravenous mitoxantrone (Novantrone; Amgen Inc; Thousand Oaks, California). Each of these treatments is only partially effective as monotherapy; patients commonly continue to experience relapses and disease progression while taking 1 of these agents. Thus, there is a high level of interest in combination therapies that involve either 2 of these therapies together or 1 of these agents combined with second-line immunotherapies (eg, methylprednisolone, cyclophosphamide, intravenous immunoglobulin [IVIG], methotrexate, azathioprine, etc.). Many authorities believe that, ultimately, the optimal therapy for MS will involve combination therapies similar to the approach used to combat other progressive dysimmune diseases (eg, cancer, AIDS, and lupus). However, very little data are available about the indications, safety, and efficacy of combination therapies for MS.

Leist and colleagues[8] treated 54 consecutive patients with add-on mitoxantrone for worsening relapsing-remitting or secondary progressive MS. At the time they started mitoxantrone, patients had been receiving Avonex (n = 21), Betaseron (n = 14), or Copaxone (n = 12) for at least 6 months, or had stopped immunotherapy (n=7). Mitoxantrone was given in at least 3 infusions of a standard dose (12 mg/m2) every 3 months. The combination of either interferon or glatiramer acetate with mitoxantrone was well tolerated. Transient decreases in serum white blood cells were most pronounced in patients receiving Betaseron, leading to a reduction in mitoxantrone dose to 10 mg/m2 in 1 patient. These data indicate that mitoxantrone, when added to established immunotherapies, does not have any unexpected adverse effects, but that close monitoring of white-cell counts is indicated in patients on Betaseron. Further studies should test the efficacy of these combination strategies in a controlled and prospective manner.
 

© 2002 Medscape